The present invention relates to a method of facilitating the supply of prescribed medical devices to a healthcare facility including the authorization process required by an insurance company. More specifically, the present invention relates to a method in which the insurance company contacts a transaction facilitator over a computer network who orders the required product and generates bills and payments without the healthcare facility being directly involved in the ordering and billing cycles.
Currently, many types of medical devices, such as automatic implantable defibrillators and implantable pacemakers, are ordered by a healthcare facility on an as-needed basis to replenish an on-site inventory maintained by the facility. Thus, the hospital needs to inventory these high priced items. The process of obtaining a device for use in a medical procedure typically follows the following sequence. Initially, a physician determines the patient's condition and prescribes a desired treatment for such condition. After the prescribed treatment has been determined, a representative from the hospital telephones the patient's insurer to gain pre-authorization for both the procedure and the medical device required for the treatment, as well as to verify the insurance coverage itself.
If the insurer pre-authorizes both the procedure and the device, the hospital contacts a desired manufacturer to order the device to be implanted or uses contingency stock on hand at the hospital. Upon receiving the order, the manufacturer delivers the medical device along with a bill for the device. After the device is implanted and after the patient has been discharged, the healthcare facility generates a purchase order to the manufacturer to begin the billing cycle.
After the hospital implants the medical device within the patient and the patient has been discharged, the hospital generates a claim to the insurance company for the cost of the implanted device, as well as for the cost of the procedure required to implant the device and the entire patient's hospital stay. In many cases, it is common for the hospital to include a 100%-200% mark-up in the claim to the insurance company for the implanted medical device.
After submitting a claim to the insurance company, the hospital waits to receive payment before in turn paying the device manufacturer.
As can be understood by the foregoing disclosure, the current billing and ordering process that exists between a hospital, an insurance company, and a device manufacturer clearly benefits the hospital, since the hospital is able to mark-up the product prior to passing the cost of the product on to the insurance company. Currently, it is not uncommon for a hospital to mark-up an implanted cardiac device by 100%-200% in the bill to the insurance company. Since the cost of the implanted device is included in a single invoice including other hospital costs, this large mark-up can be absorbed and not be apparent in the overall bill.
Further, since the manufacturer must bill the hospital, which in turn submits a claim to the insurance company, it often takes a significant amount of time before the actual money transfers from the insurance company through the hospital to the device manufacturer.
Therefore, it is an object of the present invention to provide an improved method of requesting and providing a desired implantable medical device to a hospital from the device manufacturer. Further, it is a object of the present invention to provide a method in which the transaction facilitator controls the price paid for the implantable medical device and provides the medical device to the hospital without a bill to the hospital from the device manufacturer. Further, it is a object of the present invention to provide a transaction facilitator that coordinates the delivery of the implantable device, as well as the billing and pre-authorization process, in order to alleviate the burden on both the hospital and the insurance company. Further, it is an object of the present invention to combine the separate billing cycles that exist between the insurance company, the hospital and the manufacturer into a single cycle to reduce the total time involved.